Healthcare Provider Details

I. General information

NPI: 1417570904
Provider Name (Legal Business Name): ASASE YE DURU HOLISTIC,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2020
Last Update Date: 05/19/2020
Certification Date: 05/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 W PEACHTREE ST NW
ATLANTA GA
30309-3449
US

IV. Provider business mailing address

1201 W PEACHTREE ST NW
ATLANTA GA
30309-3449
US

V. Phone/Fax

Practice location:
  • Phone: 833-811-5885
  • Fax:
Mailing address:
  • Phone: 833-811-5885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code173C00000X
TaxonomyReflexologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code374K00000X
TaxonomyReligious Nonmedical Practitioner
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code405300000X
TaxonomyPrevention Professional
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number State

VIII. Authorized Official

Name: MS. TERRINAE WATSON
Title or Position: HOLISTIC THERAPIST/OWNER
Credential: MDIV
Phone: 251-620-9196